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PubMedDate not supplied

Parotid gland tumours. Our experience and a review of the literature.

In this study the authors examine the experience of their department in treating parotid tumours, evaluating in particular the various surgical techniques as a function of the prognosis and the incidence of relapses. Between 1 January 1970 and 31 December 2002, 336 patients with parotid tumour were observed in the Department of Surgical Sciences of "La Sapienza" University in Rome. Two hundred and thirty-nine patients with benign tumours and 65 with malignant tumours were analysed. As far as histological forms were concerned, the benign forms presented a prevalence of pleomorphic adenomas (55.2%) and of Warthin's tumours (36.4%). In the case of malignant tumours, the highest incidence was found for mucoepidermoid carcinomas (29.3%). In the case of benign neoplasms, the surgical strategy opted for was preneural parotidectomy performed in 148 cases (61.9%). Relapsing pleomorphic adenomas were observed in 11.65% of patients controlled, and relapsing Warthin's tumours in 8.7%. In malignant tumours, total parotidectomy was performed in principle, with possible enlargement modulated as a function of tumour stage; owing to causes related to the neoplasm, 18 patients (38.3%) died. In the treatment of benign parotid tumours, preneural parotidectomy is the preferred surgical strategy as it significantly reduces the relapse rate and, when performed by skilled surgeons, is characterized by a complication rate comparable to that of conservative surgery. In the treatment of malignant tumours, total parotidectomy is the basic procedure; extension of the action and the use of ancillary techniques are dependent on tumour stage.

Adolescent↗

PubMed2003

[Malignant tumors of the parotid gland].

We review patients operated of parotidectomy in our ENT department of Dr. Peset Hospital from Valencia during the period 1975-2001. We sheltered an amount of 147 cases. The pathologic distribution between benign and malign tumors was as following: 121 benign tumors (83%) and 26 malign tumors (17%). Here we study malign parotid tumors, which represent 17% of total parotid tumors. Sensibility and specificity of FNA was 54% and 96.5% respectively. We performed almost with similar frequencies total and suprafacial parotidectomies in 46% and 42% of cases respectively. Total parotidectomy with facial resection is indicated in cases with tumor nerve infiltration and has been done in 8% of cases. The main complications of surgery were facial nerve dysfunction and Frey syndrome. Permanent facial nerve dysfunction and and transitory facial nerve disfunction occurred in 3.8% and 30.8% of patients respectively. Frey syndrome appeared in 10% of patients operated of parotidectomy. Recurrences occurred in 15.4% of patients.

Female↗

PubMed2004

[Benign tumors of the parotid gland].

We review patients operated of parotidectomy in our ENT department of Dr. Peset Hospital from Valencia during the period 1975-2001. We shelted an amount of 145 cases. The pathologic distribution between benign and malign tumors was as following: 119 benign tumors (83%) and 26 malign tumors (17%). Here we study benign parotid tumors, which represent 83% of total parotid tumors. We performed suprafacial parotidectomies in 72% and total parotidectomy in 19% of cases. Nodulectomy was realized in 9% of patients in those tumors that arise in the lower part of the parotid gland and usualy they were Warthin tumors. The main complications of surgery were facial nerve dysfunction and Frey syndrome. We didn't have any case of permanent facial nerve dysfunction but transitory facial nerve disfunction occurred in 26% of patients. Frey syndrome appeared in 10% of patients operated of parotidectomy. Benign mixed tumor was the only one benign tumor in recurring and the frequency was 5% of patients.

Facial Paralysis↗

PubMed2006

[Prospective cohort study on prevention of Frey syndrome in parotid surgery].

OBJECTIVE: To investigate the prevention of Frey syndrome after parotidectomy. METHODS: A prospective cohort study of 100 patients with parotid cancer who received parotid surgery was underwent in our hospital from 2001 to 2004. These patients were assigned to two groups, study group (50 cases) and control group (50 cases). The patients in the study group received parotidectomy and intraoperative placement of collagen pieces within the parotid bed, between the skin flap and the facial nerve. The patients in the control group received a conventional parotidectomy and no collagen pieces was implanted. All of the patients were followed-up and were evaluated for Frey syndrome with identical questionnaires. RESULTS: Compared with control group, the incidence rate of Frey syndrome was significantly decreased in the study group (20% vs 60%, chi(2) = 15.04, P < 0.001). Postoperative incidence of facial contour apparent deformity was 80% (40/50) in control group and 44% (22/50) in study group (chi(2) = 12.26, P < 0.001). CONCLUSIONS: Use of collagen pieces as an interposition fill barrier improves parotidectomy outcome by reducing the incidence of Frey syndrome, and it improves cosmetic results concurrently.

Adolescent↗

PubMed1992

Acinic cell carcinoma of the salivary glands. A long term follow-up study of 15 cases.

Fifteen cases of acinic cell carcinoma of the salivary glands were evaluated retrospectively with respect to histological and clinical data. DNA content assessment was carried out in six cases by cytophotometry. The majority of tumors were located in the parotid gland and were Stage I at presentation. There was a female predominance and the mean age at primary diagnosis was 51.2 years for females and 41.0 for males. The solid-acinar cell pattern was the most frequently observed and the tumors were 'diploid' in all the six cases studied. Surgery was the therapeutic modality in all cases (enucleation in seven, superficial parotidectomy in three and total parotidectomy in five) and, in four of them, was complemented with radiotherapy. The clinical course was characterized by recurrence in 10 cases, metastases occurred in three patients and one patient died of the tumor. Of the seven recurrent cases, six were treated by enucleation and one by superficial parotidectomy. The histological pattern showed no correlation with the clinical course or DNA content. Acinic cell carcinoma has a significant morbidity with a high recurrence rate which seems to be largely influenced by the type of surgery employed. Wide surgical excision of the neoplasia, which includes total parotidectomy in the parotid cases, is recommended in order to reduce the frequency of recurrence of the tumor.

Adult↗

PubMed1992

Frey's syndrome: a preventable phenomenon.

Gustatory sweating, or Frey's syndrome, is a fairly common sequela of partial or radical parotidectomy, submaxillary gland surgery, or radical neck dissection. It is caused by an anastomotic communication with facial sweat glands by parasympathetic secretomotor nerve fibers intended for the excised parotid gland; treatments, whether surgical or topical, generally have been less than satisfactory. We present the first documented prophylactic approach to Frey's syndrome that is performed during and as part of parotidectomy. The surgery involves use of the superficial aponeurotic system (SMAS) as an interposing flap to interrupt the anastomotic nerve communication with the sweat glands. The SMAS is derived from the fascia in the periauricular cheek and neck area that is continuous with the platysma muscle. In a prospective study in 55 patients undergoing elective parotidectomy, the SMAS flap was elevated during the beginning of the operative procedure once it had been determined that fashioning of the flap would in no way compromise tumor excision. In all cases, at follow-up, there has been no clinical evidence of development of Frey's syndrome. We have shown that the development of the SMAS flap in parotid gland resections is an effective new approach both as a preventative measure against Frey's syndrome and as an aesthetic improvement over the usual defect typical of parotidectomies.

Humans↗

PubMed1991

[Surgery of the parotid gland. Indications. Review of the anatomy].

The surgical division of the parotid gland in three parts or "lobes" in relation to facial nerve is a practical custom. After revising the surgical anatomy, the indications and operative technique of total parotidectomy with preservation of the facial nerve (TPP) are described. The discussion is open for pleomorphic adenomas of the superficial lobe, between some authors in favour of a superficial parotidectomy and others who perform a systematic TPP. Other surgical operations are total parotidectomy (TP) without preservation of the facial nerve, TP associated with a neck dissection, at lastly extensive or partial parotidectomies. Trans-parotid surgery uses the parotid region as an approach to neighbouring structures or regions.

Humans↗

PubMedDate not supplied

Treatment of parotid gland tumors.

A clinical review has been made of 55 patients who underwent surgery for parotid tumors between 1972 and 1987. The incidence of pleomorphic adenomas was 61.8%. The F.N.A.B. permitted us to reach a correct preoperative diagnosis in 94% of the cases. The surgical procedures we used were: enucleation in eight cases, enucleoresection in five cases, superficial parotidectomy in seven cases, total conservative parotidectomy in 28 cases, total parotidectomy sacrificing the facial nerve in four cases, extended surgery in three cases. For these last three patients a cycle of postoperative radiotherapy for a total of 6000-6500 R. was carried out. As regards complications and sequelae, we must report: temporary lesions of the facial nerve (12.76%), permanent lesions (17%), Frey's syndrome in 10.61%, while a salivary fistula arose in 6.38% of the cases. The follow-up of 47 patients allowed us to observe three recurrences in cases of pleomorphic adenomas (two after enucleoresection and one after superficial parotidectomy), three recurrences in malignant tumors treated with surgery and one recurrence after combined treatment surgery and radiotherapy.

Adolescent↗

PubMed1984

The surgical approach to recurrent pleomorphic adenoma of the parotid gland.

This is a retrospective study of 19 patients who were referred to the Department of Otolaryngology, Edinburgh Royal Infirmary with recurrent pleomorphic adenoma of the parotid gland. In the majority of patients, a superficial parotidectomy was performed as primary treatment. Recurrence of the tumour was either due to tumour implantation or inadequate surgical excision. Permanent facial paralysis occurred in three patients after revision parotidectomy. Change from pleomorphic adenoma at first operation to carcinoma in pleomorphic adenoma (malignant mixed tumour) at the second was noted in three patients who are still alive and free of recurrent tumour. Eighteen out of the 19 patients did not have further recurrences after revision parotidectomy. The surgical principles in the prevention of tumour recurrence and revision parotidectomy are discussed.

Adenoma, Pleomorphic↗

PubMed1995

[Facial motor lesion after surgery of the parotid gland].

The authors report a retrospective study of 351 parotidectomies observed during a 28 years period. The average follow-up is 28 months. Preoperative and post-operative facial nerve function, type of parotidectomy, surgical management of facial nerve and histologic diagnosis according to the revised WHO classification (1990) are presented. Type of parotidectomy and degree of tumor malignancy are statistically analyzed. It seems that occurrence of post-operative facial nerve dysfunction depends on radical parotidectomy, whereas long term dysfunction is determined by tumor malignancy. Malignant epithelial tumors of the major salivary glands proved to be radiosensitive. Apart from preoperative dysfunction, clinical involvement and impossible facial nerve dissection, the authors insist upon sparing the facial nerve, event in the case of microscopic residual tumors, and prefer postoperative radiotherapy.

Adenoma↗

PubMed1994

[Facial nerve involvement after surgery of the parotid gland].

The authors report a retrospective study of 351 parotidectomies observed during a 28 years period. The average follow-up is 28 months. Preoperative and postoperative facial nerve function, type of parotidectomy, surgical management of facial nerve, and histologic diagnosis according to the revised WHO classification (1990) are presented. Type of parotidectomy and degree of tumor malignancy are statistically analyzed. It seems that occurrence of post-operative facial nerve dysfunction depends on radical parotidectomy, whereas long term dysfunction is determined by tumor malignancy. Malignant epithelial tumors of the major salivary glands proved to be radiosensitive. Apart from preoperative dysfunction, clinical involvement and impossible facial nerve dissection, the authors insist upon sparing the facial nerve, even in the case of microscopic residual tumors, and prefer postoperative radiotherapy.

Adolescent↗

PubMedDate not supplied

[Surgical pathology of parotid gland tumors].

The records of 27 patients operated for parotid tumors were reviewed retrospectively. Pleomorphic adenoma was the most frequent tumor (37.1%) and required subtotal parotidectomy in all cases. Twenty percent presented permanent facial paralysis of the marginal mandibular branch. No recurrence has been observed in five years of follow-up. Warthin's tumor, found in 11.1% of patients, was removed by either superficial or subtotal parotidectomy. Parotidean cysts were observed in 7.4% and were excised by superficial parotidectomy. The malignant tumors included squamous cell carcinoma (22.2%), adenoid cystic carcinoma (14.8%), melanoma (3.7%), and renal-cell metastasis (3.7%). All were treated by total parotidectomy with conservation of the facial nerve in 67%. Twenty-five percent had postoperative facial paralysis and 33% developed Frey's syndrome. Thirty-three percent died in the next 5 years from locoregional metastases.

Adult↗

PubMed1999

Frey syndrome: treatment with temporoparietal fascia flap interposition.

There is a 10% to 48% reported incidence of clinically significant gustatory sweating after parotid surgery or injury. Various medical and surgical treatments have been used in the attempt to treat this socially embarrassing condition. These treatments are not always effective and often have unwanted risks and adverse effects. They also do not address the post-parotidectomy defect. Prevention of Frey syndrome and correction of the postoperative contour deformity after parotidectomy have recently been achieved by interposition of temporoparietal fascia flap between the parotid gland and the cheek skin flap at the time of parotidectomy. This article presents the first report (to our knowledge) of an established case of Frey syndrome being treated with temporoparietal fascia flap interposition.

Follow-Up Studies↗

PubMed1984

Recurrent pleomorphic adenomas of the parotid gland.

In this retrospective study of 19 cases of recurrent pleomorphic adenoma of the parotid gland, all 19 patients underwent primary surgery elsewhere, namely, lumpectomy in five cases and superficial parotidectomy in 14 cases. The age at which those patients with recurrence had originally been seen was significantly earlier than those seen in our series of cases of primary surgery for pleomorphic adenoma. If the primary operation had been a parotidectomy, the average time interval between the first and second operation was 7.7 years; however, if it had been a lumpectomy, it was ten months. Implantability of the tumor and inadequate surgery were reasons for tumor recurrence. The suggested treatment of recurrence is total parotidectomy with preservation of the facial nerve. Revision surgery has been successful in all cases with no further recurrences, except in two cases in which multiple operations had already been performed.

Adenoma, Pleomorphic↗

PubMed1993

Frey's syndrome analysis with biosensor. A preliminary study.

OBJECTIVE: Objective quantification of Frey's syndrome (gustatory sweating), following total parotidectomy. A biosensoring method of enzymatic electrodes enabling the detection of L-lactate on intact skin with the use of a skin extraction device and enzymatic electrodes is presented and analyzed. DESIGN: A criterion standard study. SETTING: This prospective trial was undertaken at our research laboratory (University of Paris [France]). Parotidectomy was performed in our department, which is a tertiary care center for parotid gland pathology. PATIENTS: Twenty-eight patients with gustatory sweating following total parotidectomy and nine control patients not operated on were asked to take part in this prospective study. MAIN OUTCOME AND MEASURES: Gustatory sweating was assessed in all patients using a clinical scale, the Minor starch iodine test, and the L-lactate biosensoring method. RESULTS: Instrumentation and assay procedure for the L-lactate biosensoring method are detailed. Statistical analysis of data was performed using the Kruskal-Wallis H Test and the Mann-Whitney U Test. Results demonstrate that this method enables objective measurement of the L-lactate on skin without the need for chemical reagents, continuous nondestructive analysis in real time, and physiological dynamic monitoring of the L-lactate rate of production after stimulus. Data achieved strongly suggested that the aberrant regeneration theory is the main clue to Frey's syndrome pathogenesis. CONCLUSION: This safe, reliable, noninvasive, objective, and highly sensitive method provides an investigative tool for clinicians as well as physiologists involved with patients presenting gustatory sweating following parotid gland surgery.

Adenoma, Pleomorphic↗

PubMed1996

Low grade salivary duct carcinoma. A distinctive variant with a low grade histology and a predominant intraductal growth pattern.

BACKGROUND: Salivary duct carcinoma (SDC) has been established as a morphologically distinct and highly aggressive (HG) malignancy of the major salivary glands. However, a low grade (LG) or intermediate grade salivary duct neoplasm has not been described. METHODS: We report the clinicopathologic findings of 10 cases believed to represent the (LG) counterpart of SDC. Immunoperoxidase stains were performed on five cases, and electron microscopy on three. RESULTS: All of the tumors occurred in adult patients with no sex predilection, and presented as slow growing parotid gland lesions. Four cases involved the superficial lobe, one the deep lobe, and one arose within an intraparotid lymph node. The exact location of the tumor within the parotid gland was not stated in four cases. The size of the tumors ranged from 0.7 to 4 cm in greatest dimension, with most measuring between 1 and 2 cm. The gross appearance was focally to predominantly cystic. Microscopically, the tumors were characterized by intraductal proliferative lesions exhibiting three main patterns: (1) cystic ducts with micropapillary, tufted, and plaque-like intraluminal projections; (2) ducts distended by a solid or pseudocribriform (fenestrated) cellular proliferation, with varied cystic dilatation; and (3) ducts exhibiting architectural atypia. The three patterns coexisted and merged in most tumors, in varying proportions. All tumors shared bland to LG cytologic features, with the exception of one that had focal high-grade cytologic ductal atypia. Despite gross circumscription, there was microscopic multifocality, and in one case, stromal invasion. By immunohistochemistry, the neoplastic cells expressed the conventional ductal and glandular epithelial cell markers in addition to strong positivity for S-100 with coexpression for CK-903. Electron microscopy confirmed the ductal phenotype of the tumors and supported an in situ process evidenced by the presence of native myoepithelial cells. Nine patients underwent total parotidectomy and one superficial parotidectomy. One patient received radiation therapy following total parotidectomy. Follow-up for 6 cases ranged from 2 to 12 years and revealed no evidence of disease. CONCLUSIONS: LG-SDC represents the LG end of the spectrum of salivary duct malignant neoplasms and exhibits differentiation towards an intercalated duct-like cell phenotype. Its relationship to HG-SDC should be further explored.

Adult↗

PubMed2002

Significance of clinical stage, extent of surgery, and pathologic findings in metastatic cutaneous squamous carcinoma of the parotid gland.

BACKGROUND: Metastatic cutaneous cancer is the most common parotid malignancy in Australia, with metastatic squamous carcinoma (SCC) occurring most frequently. There are limitations in the current TNM staging system for metastatic cutaneous malignancy, because all patients with nodal metastases are simply designated N1, irrespective of the extent of disease. The aim of this study was to analyze the influence of clinical stage, extent of surgery, and pathologic findings on outcome after parotidectomy for metastatic SCC by applying a new staging system that separates metastatic disease in the parotid from metastatic disease in the neck. METHODS: A prospectively documented series of 87 patients treated by one of the authors (COB) over 12 years for clinical metastatic cutaneous SCC involving the parotid gland and a minimum of 2 years follow-up was analyzed. These patients were all previously untreated and were restaged according to the clinical extent of disease in the parotid gland in the following manner. P1, metastatic SCC of the parotid up to 3 cm in diameter; P2, tumor greater than 3 cm up to 6 cm in diameter or multiple metastatic parotid nodes; P3, tumor greater than 6 cm in diameter, VII nerve palsy, or skull base invasion. Neck disease was staged in the following manner: N0, no clinical metastatic disease in the neck; N1, a single ipsilateral metastatic neck node less than 3 cm in diameter; N2, multiple metastatic nodes or any node greater than 3 cm in diameter. RESULTS: Clinical P stages were P1, 43 patients; P2, 35 patients; and P3, 9 patients. A total of 21 patients (24%) had clinically positive neck nodes. Among these, 11 were N1, and 10 were N2. Conservative parotidectomies were carried out in 71 of 87 patients (82%), and 8 of these had involved surgical margins (11%). Radical parotidectomy sacrificing the facial nerve was performed in 16 patients, and 6 (38%) had positive margins, (p <.01 compared with conservative resections). Margins were positive in 12% of patients staged P1, 14% of those staged P2, and 44% of those staged P3 (p <.05). Multivariate analysis demonstrated that increasing P stage, positive margins, and a failure to have postoperative radiotherapy independently predicted for decreased control in the parotid region. Survival did not correlate with P stage; however, many patients staged P1 and P2 also had metastatic disease in the neck. Clinical and pathologic N stage both significantly influenced survival, and patients with N2 disease had a much worse prognosis than patients with negative necks or only a single positive node. Independent risk factors for survival by multivariate analysis were positive surgical margins and the presence of advanced (N2) clinical and pathologic neck disease. CONCLUSIONS: The results of this study demonstrate that patients with metastatic cutaneous SCC in both the parotid gland and neck have a significantly worse prognosis than those with disease in the parotid gland alone. Furthermore, patients with cervical nodes larger than 3 cm in diameter or with multiple positive neck nodes have a significantly worse prognosis than those with only a single positive node. Also, the extent of metastatic disease in the parotid gland correlated with the local control rate. The authors recommend that the clinical staging system for cutaneous SCC of the head and neck should separate parotid (P) and neck disease (N) and that the proposed staging system should be tested in a larger study population.

Adult↗

PubMedDate not supplied

Frey's syndrome: treatment with topical glycopyrrolate.

Gustatory sweating and flushing of the facial skin, or Frey's syndrome, is fairly common after parotidectomy. The most likely mechanism is aberrant reinnervation of the sweat glands of the face by the severed parotid parasympathetic nerve fibers. A survey of 61 patients having undergone parotidectomy yielded 29 (47.5%) with gustatory sweating. Twenty-three percent (14 patients) considered the symptoms severe. In a double-blind study, five of those 14 patients were alternately treated with topically applied placebo and with glycopyrrolate (an anticholinergic agent) as 0.5% lotion, 2% lotion, and 2% cream. All five patients showed some improvement with the test preparations, but had longer lasting and more effective lessening of symptoms with the 2% glycopyrrolate preparations. There were no adverse side effects. We therefore believe that the topical application of a 2% glycopyrrolate preparation is a safe and effective treatment for severe gustatory sweating following parotidectomy.

Administration, Topical↗